(1500) Parameters to Prognosticate Children With Shock in the Pediatric Emergency Department

Introduction: Children with shock have a higher mortality rate than those without. Shock Index, Paediatric Age-Adjusted (SIPA) is used to assess shock in a paediatric patient. However, there is limited data comparing SIPA against other parameters. We aim to compare SIPA with other haemodynamic parameters, as well as their change (Δ), in identifying critically ill children. We also aim to identify shock index (SI) cut offs for children < 4 years old. We hypothesize that SIPA is a better predictor of haemodynamic instability and clinical severity than individual parameters.

Methods: A retrospective cohort study of children (≤18 years old) who visited the Emergency Department and received normal saline boluses in 2009 and from 2012-2014 was done. Primary outcome was a composite of paediatric intensive care unit (PICU) admission and/or mortality. Secondary outcome was the length of PICU stay (LOS). We compared SI, heart rate (HR), systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and change (Δ) of these parameters between the first and second readings between patients with and without both outcomes.

Results: In total, 538 patients were included with 12% (63/538) attaining the primary outcome. Overall, 61% had non-traumatic hypovolemic shock. Patients with the primary outcome received larger volumes of normal saline bolus, 20.0 (interquartile range [IQR] 12.2-33.3) vs 19.7 (IQR 10.3-20.0) ml/kg, p=0.014. Comparing children with and without the primary outcome, SBP, DBP, MAP and SI were significantly different in those < 1 year old. Patients 7-12 years of age with and without the primary outcome had significantly lower SBP, DBP and MAP. The ΔDBP, ΔMAP and ΔSI were significantly different in patients ≥13 years old. DBP (ß=-0.22), MAP (ß=-0.21) and ΔSI (ß=-6.70) were significantly associated with LOS in children aged 7-12 years old. An SI cut off of 1.98 in children < 1 year old showed AUC-ROC 0.774, sensitivity 0.75, specificity 0.71, LR+ 2 and LR- 0.35.

Conclusions: Association of PICU admission and/or mortality with different haemodynamic parameters vary between age groups. A SI cut off of 1.98 in children < 1 year old may be useful to predict the need for PICU admission and/or death but will require further studies for validation.